Side-by-side Comparison: Hospice and Palliative Medicine Competencies (version 2.3) and Pediatric-Hospice and Palliative Medicine Competencies

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1 Side-by-side Comparison: Hospice and Palliative Medicine Competencies (version 2.3) and Pediatric-Hospice and Palliative Medicine Competencies Key Red: 2.3 content deleted in the Pediatric-Hospice and Palliative Medicine Competencies Blue: Content moved to another competency or wording changed from Hospice and Palliative Medicine Competencies (version 2.3) Green: New content in the Pediatric-Hospice and Palliative Medicine Competencies Hospice and Palliative Medicine Competencies (version 2.3) Pediatric-Hospice and Palliative Medicine Competencies 1. PATIENT AND FAMILY CARE 1. PATIENT AND FAMILY CARE The fellow should demonstrate compassionate, appropriate, and effective care based on the existing evidence base in palliative medicine and aimed at maximizing the well-being and quality of life for patients with advanced, progressive, life-threatening illnesses and their families. The fellow should provide care in collaboration with an interdisciplinary team. The fellow should demonstrate compassionate, appropriate, and effective care based on the existing evidence base in pediatrics and pediatric and adult hospice and palliative medicine and aimed at maximizing the well-being and quality of life for patients with chronic, complex, and/or life-threatening conditions and their families. The fellow should provide care in collaboration with other subspecialists and in concert with an interdisciplinary team Gathers comprehensive and accurate information from all pertinent sources, including patients, family members, healthcare proxies, other healthcare providers, interdisciplinary team members, and medical records 1.1. Gathers comprehensive and accurate information from all pertinent sources, including patients, family members, guardians, other healthcare providers, interdisciplinary team members, and medical records

2 Obtains a comprehensive medical history and physical examination, including: Obtains a comprehensive medical history and physical examination, including: Patient understanding of illness and prognosis Patient and family understanding of illness and prognosis Goals of care/advance care planning/proxy decision-making Goals of care/advance care planning/proxy decision-making Detailed symptom history (including use of validated scales) Detailed symptom history (including use of validated scales) Psychosocial and coping history (including loss history) Psychosocial and coping history (including loss history) Spiritual history Spiritual history Functional assessment Functional assessment Quality-of-life assessment Quality-of-life assessment Depression evaluation (including stressors and areas of major concern) Neuropsychiatric evaluation of the patient (including stressors and areas of major concern) Pharmacologic history, including substance dependency or abuse Pharmacologic history, including substance dependency or abuse in the patient or family Detailed neurological examination, including mental status examination Detailed neurological examination, including mental status examination

3 Comprehensive social history outlining the support system for the child and family Developmental level and cognitive ability of the child Family functioning, including siblings understanding of the condition, behavior challenges, and supports Assessment of the child s role in decision making Performs appropriate diagnostic workup, reviews primary source information and evaluation, and determines prognosis and appropriate palliative course Performs appropriate diagnostic workup, reviews primary source information and evaluation, and correctly interprets diagnostic tests/procedures Uses information technology, accesses online evidencebased medicine resources, and uses electronic repositories of information and medical records Uses information technology, accesses online evidencebased medicine resources, and uses electronic repositories of information and medical records 1.2. Synthesizes and applies information in the clinical setting 1.2. Synthesizes and applies information in the clinical setting Develops a prioritized differential diagnosis and problem list Develops a prioritized differential diagnosis and problem list Develops recommendations based on patient and family values Develops interdisciplinary recommendations for palliative interventions that are aimed at reducing suffering and consistent with patient and family values and goals of care

4 Routinely obtains additional clinical information from other physicians, nurses, pharmacists, social workers, case managers, chaplains, and respiratory therapists when Routinely obtains additional clinical information from all members of the interdisciplinary team, including other involved clinicians appropriate 1.3. Demonstrates an interdisciplinary approach to developing a care plan that optimizes the patient s and family s goals and reduces suffering 1.4. Assesses and communicates the prognosis Assesses and communicates the prognosis to the patient and family 1.3. Assesses and manages patients with consideration of their developmental stage and cognitive ability 1.5. Assesses and manages patients with the full spectrum of advanced, progressive, life-threatening conditions, including common cancers, common noncancer diagnoses, chronic diseases, and emergencies 1.4. Assesses and manages patients, incorporating chronic, acute-onchronic, and emergency care with the full spectrum of pediatric lifethreatening conditions and the resultant common sequelae associated with these conditions 1.6. Manages physical symptoms, psychological issues, social stressors, and spiritual aspects of the patient and family 1.5. Assesses and manages physical symptoms, psychological/behavioral issues, social stressors, and spiritual aspects of the patient s and family s suffering

5 Assesses pain and nonpain symptoms Assesses and manages symptoms Uses opioid and nonopioid pharmacologic options Uses pharmacologic and nonpharmacologic symptom interventions Uses nonpharmacologic symptom interventions Manages neuropsychiatric disorders Assesses and manages symptoms associated with neuropsychiatric disorders Manages physical symptoms and psychosocial and spiritual distress in the patient and family Assesses and manages physical symptoms and psychosocial and spiritual distress in the patient and family Understands and addresses the interplay between physical symptoms and psychosocial and spiritual distress Understands and addresses the interplay between developmental stage and cognitive ability with physical, psychosocial, and spiritual suffering Reassesses symptoms frequently and makes therapeutic adjustments as needed Reassesses symptoms frequently and makes therapeutic adjustments as needed

6 1.7. Coordinates, orchestrates, and facilitates key events in patient care, such as family meetings, consultation around goals of care, advance directive completion, conflict resolution, withdrawal of lifesustaining therapies, and palliative sedation, involving other team members as appropriate 1.6. Coordinates, orchestrates, and facilitates key events in patient care, such as family meetings, consultation around goals of care, advance care planning, conflict resolution, forgoing or discontinuing lifesustaining therapies, discharge/transfer meetings, and sedation to unconsciousness, involving other team members as appropriate 1.8. Provides care to patients and families that reflects unique characteristics of different settings along the palliative care spectrum to ensure smooth transitions across settings of care 1.7. Provides care to patients and families that reflects unique characteristics of different settings along the palliative care spectrum to ensure smooth transitions across settings of care Performs appropriate palliative care assessment and management for the home visit, nursing home visit, inpatient hospice unit visit, outpatient clinic visit, and hospital patient visit Performs appropriate palliative care assessment and management for the home visit, long-term care facility visit, inpatient hospice unit visit, outpatient clinic visit, and hospital patient visit Delivers timely and accurate information and addresses barriers to patient and family access to palliative care in multiple settings Delivers timely and accurate information about all settings of the palliative care continuum to patients and families to facilitate choices and ensure smooth transitions across settings of care Develops awareness of and addresses barriers to patient and family access to palliative care in multiple settings

7 Works with families in an interdisciplinary manner to formulate appropriate discharge plans for patients and families Works effectively with interdisciplinary team members to assist patients and families in formulating appropriate discharge and transition-of-care plans Demonstrates an interdisciplinary approach to the development of a birthing plan that optimizes family goals and minimizes suffering for a family managing a fetus diagnosed with a life-threatening condition 1.9. Bases care on the patient s past history and patient and family preferences and goals of care, prognostic information, evidence, clinical experience, and judgment 1.8. Bases care on the patient s past history and patient and family preferences and goals of care, prognostic information, evidence, clinical experience, and judgment Demonstrates a patient- and family-centered approach to care Demonstrates a patient- and family-centered approach to care Makes recommendations to consulting physicians as appropriate Makes recommendations to consulting physicians as appropriate Demonstrates the ability to appropriately respond to suffering by addressing sources of medical and psychosocial/spiritual distress, bearing with the patient s and family s suffering and distress, and remaining a presence, as desired by the patient and family 1.9. Demonstrates the ability to respond appropriately to suffering by addressing sources of medical and psychosocial/spiritual distress, bearing with the patient s and family s suffering and distress, and remaining a presence, as desired by the patient and family

8 Recognizes and seeks to support the psychosocial and emotional needs of siblings by utilizing appropriate members of the interdisciplinary team (eg, child life, social workers, spiritual care providers, etc.) Demonstrates care that shows respectful attention to age/developmental stage, gender, sexual orientation, culture, religion/spirituality, family interactions, and disability Demonstrates care that shows respectful attention to age/developmental stage, gender, sexual orientation, culture, religion/spirituality, disability, and family interactions Seeks to maximize patients level of function and quality of life for patients and families Seeks to balance a patient s level of function and quality of life with concerns for longevity for patients and families Evaluates functional status over time Evaluates functional status over time Evaluates quality of life over time Evaluates quality of life over time Provides expertise in maximizing patients level of function and quality of life Provides expertise in maximizing patients level of function and quality of life Seeks to preserve opportunities for individual and family life in the context of life-threatening illnesses Seeks to preserve opportunities for individual and family life in the context of life-threatening conditions Recognizes the potential value to patients and their family members of completing personal affairs/unfinished business Recognizes the potential value of meaning making, creating a sense of legacy, and completing personal goals to patients and their family members

9 Effectively manages physical symptoms and psychosocial and spiritual distress in the patient and family Synthesizes information and explains to the patient and family the potential uses and limitations of technology in balancing quality of life and quantity of life (eg, tracheostomy tube) Provides patient and family education Provides patient, family, caregiver, and staff education Educates families in maintaining and improving level of function to maximize quality of life Educates families and caregivers in maintaining and improving level of function to maximize quality of life Explains palliative care services, recommendations, and latest developments to patients and families Explains palliative care services, recommendations, and latest developments to patients, families, and caregivers Educates patients and families about disease trajectory and how and when to access palliation in the future Educates patients, families, and caregivers about disease trajectory and the role of palliative care over time in the care plan Provides education to various community resources involved in the care of the child and the family (eg, schools, community hospices) Recognizes signs and symptoms of impending death and appropriately cares for imminently dying patients and their family members Recognizes signs and symptoms of impending death and appropriately cares for imminently dying patients, including care for family members and involved staff

10 Prepares the family, other healthcare professionals, and caregivers for the patient s death Prepares family, other healthcare professionals, and caregivers for the patient s death Provides appropriate assessment and symptom management for the imminently dying patient Provides appropriate assessment and symptom management for the imminently dying patient Provides treatment to the bereaved Provides treatment to the bereaved Provides support to family members at the time of death and immediately after Provides support to family members at the time of death and immediately after Involves interdisciplinary team members in treating the bereaved Involves interdisciplinary team members in treating the bereaved Refers family members to bereavement programs Refers family members to bereavement programs Refers patients and family members to other healthcare professionals to assess, treat, and manage patient and family care issues outside the scope of the palliative care practice and collaborates effectively with them Coordinates care and refers patients and family members to other healthcare professionals to assess, treat, and manage patient and family care issues outside the scope of the palliative care practice and collaborates effectively with them Recognizes the need for collaboration with clinicians providing disease-modifying treatment Recognizes the need for collaboration with clinicians providing disease-modifying and/or symptom-modifying treatment

11 Collaborates with and makes referrals to pediatricians with expertise relevant to the care of children with advanced, progressive, and life-threatening illnesses Collaborates with and makes referrals to practitioners in adult hospice and palliative care (A-HPC) with expertise or clinical practice relevant to the care of pediatric patients with life-threatening conditions (eg, hospice agencies, transitions of care) Accesses specialized pediatric and geriatric palliative Accesses specialized A-HPC resources appropriately care resources appropriately Collaborates effectively with mental health clinicians to meet the needs of patients with major mental health issues Collaborates effectively with mental health clinicians to meet the needs of patients and family members with major mental health issues 2. MEDICAL KNOWLEDGE 2. MEDICAL KNOWLEDGE The fellow should demonstrate knowledge about established and evolving biomedical, clinical, population science, and social-behavioral sciences relevant to the care of patients with life-threatening illnesses and to their families, and relate this knowledge to the hospice and palliative care practice. The fellow should demonstrate knowledge about established and evolving biomedical, clinical, population, and social-behavioral sciences relevant to the care of patients with life-threatening conditions and to their families, and relate this knowledge to the hospice and palliative care practice Describes the scope and practice of hospice and palliative medicine, including: 2.1. Describes the scope and practice of pediatric hospice and palliative care (P-HPC), including: Unique features of suffering for patients, families, and care providers in the care of children with life-threatening conditions

12 Unique features in caring for pediatric patients in regard to physiology, vulnerabilities, development, and decision-making Understanding the cultural biases that affect care of children with lifethreatening conditions and their effects on decision-making, grief and bereavement, transitions in care, and the risks and benefits of familycentered care Domains of hospice and palliative care Current standards and best practices of pediatric hospice and palliative medicine (P-HPM) Role of palliative care in comanagement of patients with potentially life-limiting illnesses at all stages of disease and in the presence of restorative, curative, and life-prolonging goals Role of palliative care in comanagement of patients with lifethreatening conditions in all stages of disease and in balancing and integrating modalities that are restorative, curative, life prolonging, or palliative and consistent with the patient s and family s goals History of hospice and palliative medicine History of P-HPC, including the evolution of P-HPC Settings where hospice and palliative care are provided Settings where hospice and palliative care are provided Elements of patient assessment and management across different hospice and palliative care settings, including home, nursing home, inpatient hospice unit, outpatient clinic, and hospital Elements of patient assessment and management across different hospice and palliative care settings, including home; hospital; inpatient hospice unit; outpatient clinic; and subacute, rehabilitation, and longterm care facilities

13 The Medicare/Medicaid hospice benefit, including essential elements of the program, eligibility, and key regulations for all levels of hospice care The Medicare/Medicaid hospice benefit, including essential elements of the program, eligibility, and key regulations for all levels of hospice care; specific understanding of how these benefits apply to children; and other variables affecting benefits, such as waivers, charity care programs, and local, regional, and federal regulations Barriers faced by patients and families in accessing hospice and palliative care services Barriers faced by patients and families in accessing hospice and palliative care services 2.2. Recognizes and describes the role of physical and cognitive development in P-HPM Describes normal physical and cognitive development of a child, including key developmental milestones, concept of illness and disease, perception and unique sources of suffering and coping, and concept of spirituality and death Recognizes abnormal physical and cognitive development of a child and its effect on patient function and care Recognizes that children often assign a meaning to and work to address these perceptions

14 Recognizes the unique sources of coping and distress for a child at each developmental stage and works to maintain the sources of coping and minimize the sources of distress (eg, minimizes separation from family for a toddler, maintains body image for an adolescent) 2.2. Recognizes the role of the interdisciplinary team in hospice and palliative care 2.3. Recognizes the role of the interdisciplinary team in hospice and palliative care Describes the role of the palliative care physician in the interdisciplinary team Describes the role of the palliative care physician in the interdisciplinary team Identifies the various members of the interdisciplinary team and their roles and responsibilities Identifies the various members of the interdisciplinary team and their roles and responsibilities Recognizes how and when to collaborate with other allied health professionals, such as nutritionists, physical therapists, respiratory therapists, occupational therapists, speech therapists, and case managers Recognizes how and when to collaborate with other allied health professionals, such as dietitians, child-life specialists, expressive therapists, spiritual care providers, physical therapists, respiratory therapists, occupational therapists, speech therapists, and case managers Describes concepts of team process and recognizes psychosocial and organizational elements that promote or hinder successful interdisciplinary team function Describes concepts of team process and recognizes psychosocial and organizational elements that promote or hinder successful interdisciplinary team function

15 2.3. Describes how to assess and communicate prognosis 2.4. Describes how to assess and communicate prognosis Identifies which elements of the patient s history and physical examination are critical to formulating prognosis for a given patient Identifies which elements of the patient s history and physical examination are critical to formulating prognosis for a given patient Describes common chronic illnesses with prognostic factors, expected natural course and trajectories, common treatments, and complications Describes common chronic illnesses with prognostic factors, expected natural course and predictable associated symptoms, trajectories, common treatments, and complications Describes effective strategies to communicate prognostic information to patients, families, and healthcare providers Describes strategies to communicate and facilitate coping with prognostic information to patients, families, and healthcare providers, including situations where the prognosis and outcome are unclear 2.4. Recognizes the presentation and management of common cancers, including their epidemiology, evaluation, prognosis, treatment, patterns of advanced or metastatic disease, emergencies, complications, associated symptoms, and symptomatic treatments 2.5. Recognizes and describes the presentation and management of pediatric life-threatening conditions, including their epidemiology, evaluation, prognosis, treatment, patterns of disease progression and advanced or metastatic disease, emergencies, complications, associated symptoms, and symptomatic treatments Identifies common diagnostic and treatment methods in the initial evaluation and ongoing management of cancer Identifies common diagnostic and treatment methods in the initial evaluation and ongoing management of pediatric lifethreatening conditions

16 Identifies common elements in prognostication for solid tumors and hematological malignancies at various stages, including the natural history of untreated cancers Identifies common elements in prognostication for pediatric life-threatening conditions at various stages, including the natural history of untreated conditions Describes patterns of advanced disease, associated symptoms, and symptomatic treatments for common cancers Identifies signs of advanced disease in pediatric lifethreatening conditions Describes the presentation and management of common complications of malignancy and emergencies in the palliative care setting 2.5. Recognizes the presentation and management of common noncancer life-threatening conditions, including their epidemiology, evaluation, prognosis, treatment, patterns of disease progression, complications, emergencies, associated symptoms, and symptomatic treatments Identifies markers of advanced disease in common noncancer life-threatening conditions, such as congestive heart failure, chronic obstructive pulmonary disease, and dementia Describes patterns of advanced disease, associated symptoms, and symptomatic treatments for common noncancer life-threatening conditions

17 Describes the presentation and management of common complications of noncancer life-threatening conditions and emergencies 2.6. Describes the types of suffering associated with pediatric lifethreatening conditions in the patient and family 2.6. Explains principles of assessing pain and other common nonpain 2.7. Explains principles of assessing and treating common symptoms symptoms Describes the concept of total pain Describes the concept of total pain, including the role of the interdisciplinary team in assessing and treating it Explains the relevant basic science, pathophysiology, associated symptoms and signs, and diagnostic options useful in differentiating among different etiologies of pain and nonpain Explains the relevant basic science, pathophysiology, associated symptoms and signs, and diagnostic options useful in differentiating etiologies of symptoms symptoms Describes a thorough assessment and functional status of pain and other symptoms, including the use of appropriate diagnostic methods and symptom measurement tools Describes a thorough, developmentally appropriate assessment of symptoms and functional status, including the use of appropriate diagnostic methods and symptom measurement tools

18 Names common patient, family, healthcare professional, and healthcare system barriers to the effective treatment of symptoms Names common patient, family, healthcare professional, and healthcare system barriers to the effective treatment of symptoms and describes common methods for overcoming these barriers Describes effective collaboration with home-care resources (eg, hospice) in treating symptoms 2.7. Describes the use of opioids in pain and nonpain symptom 2.8. Describes the pharmacologic treatment of symptoms management Lists the common agents used to treat pain, dyspnea, nausea, vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus, confusion, delirium, agitation, spasticity, seizures, and other common problems in palliative care practice Lists the indications, clinical pharmacology, alternate routes, equianalgesic conversions, appropriate titration, toxicities, and management of common side effects for opioids Describes the indications, clinical pharmacology, alternate routes, monitoring of treatment outcomes, appropriate titration, and common side effects for medications commonly used in symptom management (eg, opioid and nonopioid analgesics, adjuvant analgesics, and other pharmacologic approaches)

19 Describes appropriate opioid prescribing, monitoring of treatment outcomes, and toxicity management in chronic, Describes appropriate prescribing, including off-label indications and uses of pharmacologic interventions urgent, and emergency pain conditions Describes appropriate opioid prescribing in different clinical care settings, such as the home, residential hospice, hospital, and long-term care facility Describes appropriate prescribing in different clinical care settings, such as the home, hospital, intensive care unit, long-term care facility, and inpatient hospice Describes the challenges unique to the use of opioids in symptom management, including Equianalgesic conversions Describes the concepts of addiction, pseudoaddiction, dependence and tolerance, and describes their significance in pain management, as well as approaches to managing pain in patients with current or prior substance abuse Concepts of addiction, pseudoaddiction, dependence and tolerance, and their significance in symptom management, as well as approaches to management in patients with current or prior substance abuse Explains the legal and regulatory issues surrounding Legal and regulatory issues surrounding opioid prescribing opioid prescribing Common barriers to effective use of opioids (eg, individual, cultural, conceptual misunderstanding; side effects) and common strategies in overcoming these barriers (eg, family education, clear goals of therapy)

20 Describes the importance of pain control and sedation during procedures in the care of pediatric patients Describes effective collaboration with home-care resources (eg, hospice) in treating symptoms 2.8. Describes the use of nonopioid analgesics, adjuvant analgesics, and other pharmacologic approaches to the management of both pain and nonpain symptoms Identifies the indications, clinical pharmacology, alternate routes, appropriate titration, toxicities, and management of common side effects for acetaminophen, aspirin, NSAIDs, corticosteroids, anticonvulsants, antidepressants, and local anesthetics used in the treatment of pain and nonpain symptoms 2.9. Describes pharmacologic approaches to the management of common nonpain symptoms Describes uses of common agents used to treat dyspnea, nausea, vomiting, diarrhea, constipation, anxiety, depression, fatigue, pruritus, confusion, agitation, and other common problems in palliative care practice

21 Identifies the indications, clinical pharmacology, alternate routes, appropriate titration, toxicities, and management of common side effects for opioids, anxiolytics, antiemetics, laxatives, psychostimulants, corticosteroids, antidepressants, antihistamines, neuroleptics, sedatives, and other common agents used in palliative care practice Describes the use of nonpharmacologic approaches to the management of pain and nonpain symptoms 2.9. Describes the use of procedural, interventional, and nonpharmacologic approaches to the management of symptoms Identifies indications, toxicities, and appropriate referral for interventional pain management procedures as well as surgical procedures commonly used for pain and nonpain Identifies indications, risks, and appropriate referral for interventional pain management procedures, including surgical procedures, commonly used for symptom management symptom management Identifies indications, toxicities, management of common side effects, and appropriate referral for radiation Identifies indications, risks, management of common side effects, and appropriate referral for radiation therapy therapy Identifies indications, toxicities, and appropriate referral for commonly used complementary and alternative therapies Identifies indications, risks, and appropriate referral for commonly used complementary and alternative therapies Explains the role of allied health professions in pain and nonpain symptom management Explains the role of allied health professions in symptom management

22 2.11. Describes the etiology, pathophysiology, diagnosis, and management of common neuropsychiatric disorders encountered in palliative care practice, such as depression, delirium, seizures, and brain injury Describes the etiology, pathophysiology, diagnosis, and management of common neuropsychiatric disorders encountered in palliative care practice, such as depression, anxiety, delirium, seizures, and brain injury Recognizes how to evaluate and treat common neuropsychiatric disorders Recognizes how to evaluate and treat common neuropsychiatric disorders Describes how to refer appropriately to neurological and mental health professionals Describes how to refer appropriately to neurological and mental health professionals Describes the indications, contraindications, pharmacology, appropriate prescribing practice, and side effects of common psychiatric medications Describes the indications, contraindications, pharmacology, appropriate prescribing practice, and side effects of common psychiatric medications Recognizes the diagnostic criteria and management issues of brain death, persistent vegetative state, and minimally conscious state Recognizes the diagnostic criteria and management issues of brain death, persistent vegetative state, and minimally conscious state Recognizes common psychological stressors and disorders experienced by patients and families facing life-threatening conditions, and describes appropriate clinical assessment and management Recognizes common psychological stressors and disorders experienced by patients and families facing life-threatening conditions, and describes appropriate clinical assessment and management Recognizes psychological distress Recognizes psychological distress in patients, families, and care providers

23 Describes concepts of coping styles, psychological defenses, and developmental stages relevant to the evaluation and management of psychological distress Describes concepts of coping styles, psychological defenses, and developmental stages relevant to the evaluation and management of psychological distress Describes how to provide basic, supportive counseling and how to strengthen coping skills Describes how to provide basic, supportive counseling, and coaches families and care providers to maintain important developmentally appropriate supports and to strengthen coping skills Recognizes the needs of minor children when an adult parent or close relative is seriously ill or dying, and provides appropriate basic counseling or referral Recognizes the needs of minor children when an adult parent or close relative is seriously ill or dying, and provides appropriate basic counseling or referral Recognizes the needs of parents and siblings of children who are seriously ill or dying and provides appropriate basic counseling or referral Recognizes the needs of parents and siblings of children who are seriously ill or dying and provides appropriate basic counseling or referral Explains appropriate utilization of consultation with specialists in psychosocial assessment and management Explains appropriate utilization of consultation with specialists in psychosocial assessment and management Explains appropriate strategies to support and educate parents and care providers in recognizing psychological distress in children and appropriate ways to support them, including communication, truth telling, supporting coping, and recognizing when to ask for help

24 Describes typical coping mechanisms and important supports specific to each developmental stage Recognizes common social problems experienced by patients and families facing life-threatening conditions and describes appropriate clinical assessment and management Recognizes common social problems experienced by patients and families facing life-threatening conditions and describes appropriate clinical assessment and management Is able to assess, counsel, support, and make referrals to alleviate the burden of caregiving Is able to assess, counsel, support, and make referrals to alleviate the burden of caregiving Is able to assess, provide support, and make referrals around fiscal issues, insurance coverage, and legal concerns Is able to assess, provide support, and make referrals around fiscal issues, insurance coverage, and legal concerns Is able to assess the patient s key relationships, including family structure, and determine legal decision makers and important participants in decision making for the patient Understands and describes effective strategies to interact with and advocate for children in child protective services Recognizes common experiences of distress around spiritual, religious, and existential issues for patients and families facing lifethreatening conditions, and describes elements of appropriate clinical assessment and management Recognizes common experiences of distress around spiritual, religious, and existential issues for patients and families facing lifethreatening conditions, and describes elements of appropriate clinical assessment and management

25 Describes the role of hope, despair, meaning, and transcendence in the context of severe and chronic illness Describes the role of hope, despair, and meaning making in the context of life-threatening conditions Describes the role of development in the patient s understanding of spirituality and death Describes how to perform a basic spiritual/existential/religious evaluation Describes how to perform a basic spiritual/existential/religious evaluation Describes how to provide basic spiritual counseling Describes how to provide basic spiritual counseling Identifies the indications for referral to chaplaincy or other spiritual counselors and resources Identifies the indications for referral to spiritual care providers or other spiritual counselors and resources Knows the developmental processes, tasks, and variations of life completion and life closure Knows the developmental processes, tasks, and variations of meaning making for patients at the end of life and their families Describes processes for facilitating growth and development in the context of advanced illness Describes processes for facilitating growth and development in the context of advanced illness Describes a child s developmental understanding of spirituality and death across the age spectrum

26 Describes to families the child s developmental understanding of spirituality and coaches them on how to best provide support to the child Is able to recognize, evaluate, and support diverse cultural values and customs with regard to information sharing, decision making, expression and treatment of physical and emotional distress, and preferences for sites of care and death Is able to recognize, evaluate, and support diverse cultural values and customs with regard to information sharing, decision making, expression and treatment of physical and emotional distress, and preferences for sites of care and death Recognizes major contributions from nonmedical disciplines such as sociology, anthropology, and health psychology in understanding and managing the patient s and family s experience of serious and life-threatening illnesses Recognizes major contributions from nonmedical disciplines such as sociology, anthropology, and health psychology in understanding and managing the patient s and family s experience of serious and lifethreatening conditions Recognizes the components of appropriate management for the syndrome of imminent death Recognizes the components of appropriate management for the syndrome of imminent death Identifies common symptoms, signs, complications, and variations in the normal dying process and their Identifies common symptoms, signs, complications, and variations in the normal dying process and their management management Describes strategies to communicate with the patient and family about the dying process and provide support Describes strategies to communicate with the patient and family about the dying process and provide support

27 2.17. Recognizes the elements of appropriate care of the patient and family at the time of death and immediately thereafter Recognizes the elements of appropriate care of the patient and family at the time of death and immediately thereafter Describes appropriate and sensitive pronouncement of death Describes appropriate and sensitive pronouncement of death Identifies the standard procedural components and psychosocial elements of postdeath care Identifies the standard procedural components and psychosocial elements of postdeath care Recognizes the potential importance and existence of postdeath rituals and how to facilitate them Recognizes the potential importance and existence of postdeath rituals and how to facilitate them Recognizes benefits and challenges posed by a death in different care settings (eg, hospital, home) and describes resources and strategies to address them Describes the basic science, epidemiology, clinical features, natural course, and management options for normal and pathologic grief Describes the basic science, epidemiology, clinical features, natural course, and management options for normal and pathologic grief Demonstrates knowledge of normal grief and elements of bereavement follow-up, including assessment, treatment, and referral options for bereaved family members Demonstrates knowledge of typical grief patterns and elements of bereavement follow-up, including assessment, treatment, and referral options for bereaved family members

28 Recognizes the risk factors, diagnostic features, epidemiology, and management of depression and prolonged grief disorder Recognizes the risk factors, diagnostic features, epidemiology, and management of depression and prolonged grief disorder Recognizes, differentiates, and describes strategies to address grief and bereavement, including the unique features associated with the loss of a child, the role of anticipatory grief in medical decision making, and factors that facilitate and benefit the grieving process prior to and following the death of a child Appreciates risk of suicide in the bereaved and carries out an initial assessment for suicide risk Appreciates risk of suicide in the bereaved and carries out an initial assessment for suicide risk Recognizes compassion fatigue and care provider grief and describes the role of and effective strategies for addressing them in patient care Describes the challenges of utilizing effective strategies for collaborating with A-HPC practitioners and resources in the care of pediatric patients

29 Recognizes situations in which partnering with A-HPC practitioners and resources is necessary for a P-HPC team in the care of a pediatric patient (eg, home hospice when no pediatric home hospice is available) Describes the benefits and challenges of utilizing A- HPC practitioners (eg, hospice nurses, adult hospice and palliative medicine [A-HPM] subspecialists) in the care of pediatric patients Assesses the learning needs of and describes effective coaching strategies for A-HPC practitioners in the care of pediatric patients Explains and describes strategies to address the challenges of transitioning care from P-HPC to A-HPC Describes common issues in the palliative care management of pediatric and geriatric patients and their families that differ from caring for adult patients, in regard to physiology, vulnerabilities, and developmental stages Describes the epidemiology of pediatric life-threatening conditions

30 Appreciates developmental perspectives on illness, grief, and loss Describes pharmacologic principles applicable to the management of symptoms in infants, children, adolescents, and geriatric patients Describes ethical and legal issues in palliative and end-of-life care and their clinical management Describes ethical and legal issues in palliative and end-of-life care and their clinical management Discusses ethical principles and frameworks for addressing clinical issues Discusses ethical principles and frameworks for addressing clinical issues Describes federal, state, and local laws and practices that impact palliative care practice Describes federal, state, and local laws and practices that impact palliative care practice Consults a clinical ethicist when necessary Consults a clinical ethicist when necessary Describes professional and institutional ethical policies relevant to palliative care practice Describes professional and institutional ethical policies relevant to palliative care practice 3. PRACTICE-BASED LEARNING AND IMPROVEMENT 3. PRACTICE-BASED LEARNING AND IMPROVEMENT The fellow should be able to investigate, evaluate, and improve personal practices in caring for patients and families and appraise and assimilate scientific evidence relevant to palliative care. The fellow should be able to investigate, evaluate, and continuously improve personal practices in caring for patients and families and appraise and assimilate scientific evidence relevant to palliative care.

31 3.1. Maintains a safe and competent practice, including self-evaluation and continuous learning 3.1. Maintains a safe and competent practice, including self-evaluation and continuous learning Demonstrates an ability to reflect on personal learning deficiencies and develop a plan for improvement Demonstrates an ability to reflect on personal learning strengths, deficiencies, and limits and develop a plan for improvement Demonstrates knowledge of and commitment to continuing professional development and lifelong learning Demonstrates knowledge of and commitment to continuing professional development and lifelong learning Demonstrates knowledge of the roles and responsibilities of the trainee/mentor Demonstrates knowledge of the roles and responsibilities of the trainee/mentor Demonstrates the ability to reflect on his or her personal learning style and use different opportunities for learning Demonstrates the ability to reflect on his or her personal learning style and use different opportunities for learning Demonstrates the ability to actively seek and use feedback Demonstrates the ability to actively seek and use feedback Demonstrates the ability to develop an effective learning relationship with members of the faculty and other Demonstrates the ability to develop an effective learning relationship with members of the faculty and other professionals professionals 3.2. Accesses, analyzes, and applies the evidence base to clinical practice in palliative care 3.2. Accesses, analyzes, and applies the evidence base to clinical practice in palliative care

32 Demonstrates knowledge of and recognizes limitations of evidence-based medicine in palliative care Demonstrates knowledge of and recognizes limitations of evidence-based medicine in palliative care Actively seeks to apply the best available evidence to patient care to facilitate safe, up-to-date clinical practice and encourages others to do so Actively seeks to apply the best available evidence to patient care to facilitate safe, up-to-date clinical practice and encourages others to do so 3.3. Develops competencies as an educator 3.3. Develops competencies as an educator Recognizes the importance of assessing learning needs in initiating a teaching encounter Recognizes the importance of assessing learning needs in initiating a teaching encounter Reflects on the benefits and drawbacks of alternative approaches to teaching and the role of different teaching techniques to address knowledge, attitudes, and skills Reflects on the benefits and drawbacks of alternative approaches to teaching and the role of different teaching techniques to address skills, knowledge, and attitudes Shows respect toward learners Shows respect toward learners and teachers, including children and families Describes the importance of defining learning goals and objectives as a basis for developing educational sessions Describes the importance of defining measurable learning goals and objectives as a basis for developing educational sessions

33 Demonstrates the ability to supervise clinical trainees (eg, medical students, residents, other healthcare professionals) and give constructive feedback Demonstrates the ability to supervise clinical trainees (eg, medical students, residents, other healthcare professionals) and effectively give constructive feedback 3.4. Demonstrates knowledge of the process and opportunities for research in palliative care 3.4. Demonstrates knowledge of the process, benefits, challenges, and opportunities for scholarly activity and research in palliative care Recognizes and values the importance of addressing ethical issues in palliative care research Recognizes and values the importance of addressing ethical issues in palliative care research Is realistic about the benefits and challenges of palliative care research and supports research as appropriate to the Supports and participates in scholarly activity and research as appropriate to the setting setting Recognizes and values the use of data to demonstrate clinical, utilization, and financial outcomes of palliative care Recognizes and values the use of data to demonstrate clinical, utilization, and financial outcomes of palliative care 3.5. Describes common approaches to quality and safety assurance 3.5. Describes common approaches to quality and safety assurance Demonstrates an openness and willingness to evaluate and participate in practice and service improvement Demonstrates an ability to evaluate, design, and implement quality and safety improvement and assurance measures Demonstrates knowledge of palliative care s clinical, financial, and quality-of-care outcome measures Demonstrates knowledge of palliative care s clinical, financial, and quality-of-care outcome measures

34 3.5.3.Demonstrates an awareness of and adherence to patient safety standards Demonstrates an awareness of and adherence to patient safety standards 4. INTERPERSONAL AND COMMUNICATION SKILLS 4. INTERPERSONAL AND COMMUNICATION SKILLS The fellow should be able to demonstrate interpersonal and communication skills that result in effective relationship building, information exchange, emotional support, shared decision making, and teaming with patients, their patients families, and professional associates. The fellow should be able to demonstrate interpersonal and communication skills that result in effective relationship building, information exchange, emotional support, shared decision making, and collaboration with patients, patients families, and professional associates Initiates informed, relationship-centered dialogues about care 4.1. Initiates informed, relationship-centered dialogues about care Assesses patient and family wishes regarding the amount of information they wish to receive and the extent to which they want to participate in clinical decision-making Assesses patient and family wishes regarding the amount of information they wish to receive and the extent to which they want and are able to participate in clinical decisionmaking Assesses the developmental level and cognitive understanding of the patient and appropriately includes the patient in medical discussions and decision making Determines, in collaboration with the patient and family, the appropriate participants in discussions concerning the patient s care Determines, in collaboration with the patient and family, the appropriate participants in discussions concerning the patient s care

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